1. Prescription Electronic Reporting System (KASPER)
An Update on the
Kentucky All Schedule
Prescription Electronic Reporting System
(KASPER)
David R. Hopkins
KASPER Program Manager
Office of Inspector General
Kentucky Cabinet for Health and Family Services
Kentucky Academy of Family Physicians
September 16, 2016

2. Disclosure David R. Hopkins No relevant financial relationships.
No conflicts of interest.
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3. Contents Controlled Substance Abuse KASPER Program Update
Legislative Changes Affecting Provider Use of KASPER
Enhancements to eKASPER
Provider Shopping and Diversion
House Bill 1 Results
Buprenorphine/Naloxone and KASPER
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4. Controlled Substance Abuse

5. Misuse, Abuse, Diversion ( SAMHSA)
incorrect use of a controlled substance medication by a patient (wrong time, wrong dose, wrong reason)
Abuse:
maladapted pattern of controlled substance use leading to significant impairment or distress
Diversion:
controlled substance medication leaving the legal distribution channels (manufacture, transport, pharmacy, patient)
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6. Kentucky’s Prescription Drug Abuse Strategy Office of Drug Control Policy
Require physician ownership of pain management facilities
Limit C-II prescriber dispensing to 48 hour supply
Require 7.5% of CME in addiction, pain management or KASPER
Increase public awareness
Increase drug disposal opportunities
Enhance use of Prescription Drug Monitoring Program
Require daily reporting to KASPER
Mandate KASPER registration and usage
Pharmacists must register
Controlled substance prescribers must register and query under certain circumstances
Utilize KASPER Advisory Council to identify inappropriate or illegal controlled substance prescribing
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7. Painkiller Prescription Rates by State
CDC Vitalsigns July 2014, Source: IMS, National Prescription Audit (NPAtm), 2012
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8. Adderall & Ritalin
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9. Top 10 State Drug Overdose Death Rates – 2014
Rank
State
Number of Drug Overdose Deaths
Age-Adjusted Drug Overdose Death Rate per 100,000 or Population 1
West Virginia
627
35.5 2
New Mexico
547
27.3 3
New Hampshire
334
26.2 4
Kentucky
1,077
24.7 5
Ohio
2,744
24.6 6
Rhode Island
247
23.4 7
Utah
603
22.4 8
Pennsylvania
2,732
21.9 9
Delaware
189
20.9 10
Oklahoma
777
20.3
United States
47,055
14.7
Data source: Increases in Drug and Opioid Overdose Deaths – United States, Rudd, Aleshire, Zibbell and Gladdin, CDC Morbidity and Mortality Weekly Report, December 18, 2015
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10. Kentucky Drug Overdose Deaths
Sources: 2015 Data: 2015 Overdose Fatality Report. Kentucky Justice and Public Safety Cabinet, June Data: U.S. Centers for Disease Control, Multiple Cause of Death Data (CDC Wonder Online Database)
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11. Top 10 State Drug Overdose Death Rates – 2014
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12. Controlled Substance Usage 2015
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13. Story reported by Ann Bowden, WLKY.com, December 8, 2014
Heather Pereira
-Investigators believe Allen gave his son the narcotic on the night of his death
Story reported by Ann Bowden, WLKY.com, December 8, 2014
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14. Louisville Courier-Journal, August 29, 2014
Danielle Cogswell
Louisville Courier-Journal, August 29, 2014
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15. Amanda Foster and Douglas Allen
-Investigators believe Allen gave his son the narcotic on the night of his death
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16. Prince
Story by Ralph Ellis and Sarah Sidner, CNN, June 3, 2016 , Photo by Los Angeles Times
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17. KASPER Program Update

18. Status of Prescription Drug Monitoring Programs (PDMPs)VT ME WA MT ND
NH MA RI CT NJ DE MD DC MN NY OR WI SD ID MI WY PA IA NE OH IL IN NV WV UT VA CO KS KY CA MO NC TN OK SC AZ NM AR GA MS AL TX LA AK FL
Operational PDMPs
Enacted PDMP legislation, but
program not yet operational
Legislation pending HI GU
Research is current as of February 1, 2012

19. 2011 KASPER Reports Requested
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20. Annual KASPER Records Total / Per Person
Number of Controlled Substance Prescriptions per Person
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21. KASPER Reports Requested
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22. Buprenorphine-Naloxone 3.1%
Top Prescribed Controlled Substances by Therapeutic Category by Doses
Amphetamine 3.9%
Adderall
Zolpidem 3.2%
Ambien
Buprenorphine-Naloxone 3.1%
Suboxone
Lorazepam 4.0%
Ativan
Hydrocodone 37.6%
Lortab
Vicodin
Diazepam 4.0%
Valium
Clonazepam 7.1%
Klonopin
Tramadol 9.8%
Ultram
Alprazolam 10.4%
Xanax
Oxycodone 16.9% OxyContin
Percocet
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23. KASPER Stakeholders
Licensing Boards – to investigate potential inappropriate prescribing by a licensee.
Practitioners and Pharmacists – to review a current patient’s controlled substance prescription history for medical or pharmaceutical treatment.
Law Enforcement Officers, OIG employees, Commonwealth’s attorneys, county attorneys - to review an individual’s controlled substance prescription history as part of a bona fide drug investigation or drug prosecution.
Medicaid – to screen members for potential abuse of pharmacy benefits and to determine “lock-in”; to screen providers for adherence to prescribing guidelines for Medicaid patients.
A judge or probation or parole officer – to help ensure adherence to drug diversion or probation program guidelines.
Medical Examiners engaged in a death investigation
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24. Legislative Changes Affecting Provider Use of eKASPER

25. eKASPER Reporting
Controlled substance administration or dispensing must be reported within one day
Not required for patients in hospitals, long term care facilities, child caring facilities, jails, correction facilities, juvenile detention facilities
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26. KASPER Data KASPER tracks:
Retail pharmacies dispensing into KY (in-state, mail order, Internet)
Hospital pharmacies if dispensing any C-II or more than a 72 hour supply of a C-III through C-V
Physician administering or dispensing a C-II through C-V in the office
Dispensing from Department for Veterans Affairs pharmacies
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27. KASPER Data KASPER does not track
Methadone administered at a federally regulated methadone clinic
Controlled substances dispensed for administration to a patient in a hospital, long-term care facility, jail, correctional facility or juvenile detention facility
Pseudoephedrine (tracked separately via NPLEx)
Dispensing by military pharmacies
Schedule I or other illegal drugs
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28. eKASPER Accounts
eKASPER registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans.
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29. eKASPER Prescriber Usage - KRS 218A.172
Query eKASPER for previous 12 months of data:
Prior to initial prescribing or dispensing of a Schedule II controlled substance
No less than every three months
Review data before issuing a new prescription or refills for a Schedule II controlled substance
Additional rules/exceptions included in licensure board regulations
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30. KBML Controlled Substance Prescribing Regulation
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31. KBML Controlled Substance Prescribing Regulation
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32. eKASPER Review KAR 9:260
Initial prescribing to treat acute, non-cancer pain. Including in Emergency Department
Commencement of long term prescribing (after 90 days) to treat non-cancer pain
Continued long term prescribing for non-cancer pain: every three months. More frequently or immediately if indicated
Initial treatment of non-pain conditions
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33. eKASPER Query Exceptions
In an emergency situation (disaster or mass casualties)
Patients in hospitals and long term care facilities (C-III through C-V)
Patients in Hospice care or being treated for cancer pain
Single doses of anxiety medicine prior to a procedure
Schedule V controlled substances
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34. To Request an eKASPER Report
Via secure WEB application.
Application accessible from any PC with WEB access.
Practitioners and pharmacists can receive a report often within seconds (as long as the report does not require further review by the KASPER staff).
Available 24 / 7.
URL:
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35. eKASPER Report Processing
96% of reports auto-matched by eKASPER
Manual Queue:
Processed 8:00 a.m. to 4:30 p.m. Monday through Friday
Weekday manual reports typically available within one hour
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36. eKASPER Report Request - Master
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37. eKASPER Report Request – State Selection
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38. What if I cannot “Query” KASPER?
If eKASPER indicates “manual process”
Record the eKASPER report request number in the patient’s chart
If the eKASPER system is unavailable or Internet access unavailable
Document circumstances why eKASPER could not be queried (201 KAR 9:260)
If eKASPER outage, record the date and time, and eKASPER system outage logs will confirm lack of system availability
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39. What’s New with eKASPER!
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40. KASPER Tips (www.chfs.ky.gov/KASPER)
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43. Morphine Equivalent Dose (MED)
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44. eKASPER Prescriber Reports
CS prescribers can obtain an eKASPER report on themselves (reverse KASPER):
To review and assess the individual prescribing patterns
To determine the accuracy and completeness of information contained in eKASPER
To identify fraudulent prescriptions
Prescriber Peer Comparison Report
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45. KASPER Case Study

46. eKASPER Prescriber Report Request
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48. Providing Reports to Patients
eKASPER reports can be shared with the patient or person authorized to act on the patient’s behalf
eKASPER reports can be placed in the patient’s medical record, with the report then being deemed a medical record subject to disclosure on the same terms and conditions as an ordinary medical record
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49. eKASPER Error Correction
Patient or provider should contact the dispenser to correct records in error
Inaccurate eKASPER reports due to system errors should be reported to the Drug Enforcement and Professional Practices Branch
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50. eKASPER Support Help desk e-mail ekasperhelp@ky.gov Help desk phone
(502)
Account assistance:
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51. Potential KASPER Changes
Scheduling gabapentin as a C-V
Addition of non-fatal drug overdose information to prescriber and dispenser reports
Addition of drug conviction information to KASPER reports
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52. Provider Shopping and Diversion

53. Provider Shopping
Provider shopping is when controlled substances are acquired by deception.
Acts related to attempting to obtain a controlled substance, a prescription for a controlled substance or administration of a controlled substance, prohibited under KRS 218A.140 include:
Knowingly misrepresenting or withholding information from a practitioner.
Providing a false name or address.
Knowingly making a false statement.
Falsely representing to be authorized to obtain controlled substances.
Presenting a prescription that was obtained in violation of the above.
Affixing a false or forged label to a controlled substance receptacle.
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54. Practitioner Judgment
Practitioners must use their best professional judgment to determine:
when they can intervene with a provider shopping patient and provide treatment or refer them to treatment
follow Kentucky Board of Medical Licensure guidelines in 902 KAR 9:260
when they need to contact law enforcement to report a provider shopper
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55. Diversion
Diversion involves illegal transfer of controlled substances to an individual other than for whom they were prescribed.
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56. Diversion What do you do when diversion is suspected?
If you suspect an individual is involved in diverting controlled substances, we ask that you please report them to the proper law enforcement authorities.
If unsure who to contact please call the Drug Enforcement and Professional Practices Branch of the Office of the Inspector General for assistance.
(502)
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57. Drug Enforcement and Professional Practices Branch
DEPPB Phone Number:
Paula York
Jill Lee
Stephanie Johnson
Carrie Gentry
Laura Beth Wells
Duncan McCracken
Chris Johnson
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58. Reporting Provider Shoppers/Diverters
KRS 218A.280 Controlled substances – Communications with practitioner not privileged.
Information communicated to a practitioner in an effort unlawfully to procure a controlled substance, or unlawfully to procure the administration of any controlled substance, shall not be deemed a privileged communication.
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59. Reporting Provider Shoppers/Diverters
902 KAR 55:110 Section 10 (4) (b): In addition to the purposes authorized under KRS 218A.202(8)(e), and pursuant to KRS 218A.205(2)(a) and (6), a practitioner or pharmacist who obtains KASPER data or a report under KRS 218A.202(6)(e)1. or who in good faith believes that any person, including a patient, has violated the law in attempting to obtain a prescription for a controlled substance, may report suspected improper or illegal use of a controlled substance to law enforcement or the appropriate licensing board.
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60. House Bill 1 Results

61. Controlled Substance Dispensing Comparison
Drug
July 2011 through
June 2012
July 2014
through
June 2015
Percent
Change
Hydrocodone
3,303,453
2,603,642
- 21.2%
Oxycodone
977,256
937,530
- 4.1%
Oxymorphone
24,485
18,459
- 24.6%
Tramadol
431,455
542,930
+ 25.8%
Alprazolam
947,672
769,814
- 18.8%
Diazepam
413,983
350,685
- 15.3%
Buprenorphine/ Naloxone
269,488
491,130
+ 82.2%
All Controlled Substances
10,417,237
9,927,621
- 4.7%
Whack a mole- started really good.
Figures represent number of prescriptions dispensed as reported to KASPER

62. Hydrocodone
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63. Oxycodone
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64. Alprazolam
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65. Methadone
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66. Tramadol
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67. Buprenorphine/Naloxone and KASPER

68. Buprenorphine Prescribing
Must have DEA data waiver to prescribe buprenorphine!
Request eKASPER prior to initiating treatment
Request eKASPER at least once every three months to help guide the treatment plan
201 KAR 9:270. Professional standards for prescribing or dispensing Buprenorphine-Mono-Product or Buprenorphine-Combined-with-Naloxone.
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69. Reporting of DEA data waiver numbers instead of prescriber DEA numbers
Challenges
Reporting of DEA data waiver numbers instead of prescriber DEA numbers
Electronic prescribing of controlled substances (EPCS)
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70. Buprenorphine/Naloxone
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71. Buprenorphine/Naloxone Prescribing 1Q 2016
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72. Buprenorphine/Naloxone Usage 1Q 2016
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73. Kentucky Cabinet for Health and Family Services
QUESTIONS?
David R. Hopkins
Kentucky Cabinet for Health and Family Services
275 East Main Street, 5ED
Frankfort, KY
ext. 3333
KASPER Web Site: